Natural birth control: how does it work?

Fertility awareness method

What is the fertility awareness method?

The fertility awareness method is a method of contraception where you monitor fertility signals throughout your menstrual cycle. It is known by several names, including natural family planning, the symptothermal method and the standard days method.

Your body goes through natural changes throughout your menstrual cycle to prepare for pregnancy. By tracking these changes, you can predict when you’re most likely to get pregnant.

You will need to see a fertility awareness specialist in order to use this method, as they will teach and show you how to use it effectively.

How does fertility awareness work?

Natural family planning involves tracking three main factors: your menstrual cycle, body temperature and cervical mucus. These factors indicate when you’re likely to be most fertile, more specifically when you are most likely to ovulate.

Ovulation is the process in which one of your ovaries releases an egg into the fallopian tube. When you get pregnant, the sperm from a man reaches the egg and fertilises it to become pregnant.

The aim of fertility awareness is to measure certain factors to predict when you’re ovulating so you can avoid having unprotected sex during those times, either through not having sex at all or by using barrier contraception (e.g. condoms, caps or spermicide).

Tracking your menstrual cycle

The average menstrual cycle lasts around 28 days, but between 21 - 40 days is normal. It starts on the first day of your period until the day before your next period starts.

Around 10 - 16 days before your next period, ovulation happens and an egg is released. This egg lives for around 24 hours, and sperm must reach the egg within that time in order to become pregnant. Occasionally, a second egg is released 24 hours after the first.

Therefore, your most fertile days are up to 2 days after you ovulate. You can also get pregnant up to 7 days before you ovulate, as sperm can live in a woman’s body for up to 7 days. By the third day, you are no longer fertile.

Tracking your menstrual cycle each month will help you learn when ovulation for you naturally occurs, so you can avoid sex around these times. This can be difficult to predict, so will require up to 12 months of closely tracking your cycle.

Some people just track their ovulation as a contraceptive method, known as the rhythm method or calendar method.

Measuring your body temperature

The second factor you measure is your temperature. This is because your basal body temperature will rise slightly just after you ovulate.

To track your body temperature, you’ll have to measure your body temperature every morning before you get out of bed. You should not eat or drink anything before measuring your temperature.

You must use a digital thermometer or a thermometer specifically designed for family planning, as forehead or ear thermometers are not accurate enough.

When your temperature is higher than the previous 6 days for 3 days in a row, it is most likely that you are no longer fertile. Your temperature will only be slightly higher, around 0.2°C higher. This is due to the rise in progesterone levels after you ovulate.

The temperature method should not be used on its own.

Cervical mucus monitoring

The lining of your cervix, known as your cervical mucus or cervical fluid, will change throughout your menstrual cycle as your hormonal levels change. Following these changes will help you monitor when you’re most fertile.

You can check your cervical fluid by inserting your finger into your vagina. Gently place your middle finger into your vagina until around your middle knuckle. Your vaginal discharge may also help to identify when your fertile windows are.

Most women’s cervical fluid will change in distinct stages:

• just after your period - there will be little cervical fluid and your cervix will feel dry because hormone levels are low
• around days 9-10 in typical cycles - you’ll start to feel that the fluid is more moist and sticky as your oestrogen levels rise to prepare for ovulation
• immediately before ovulation - your cervical fluid will be stretchy, slippery and become clearer as oestrogen levels peak (many describe it as looking like egg whites)
• after ovulation (luteal phase) - the mucus will start to feel more sticky or absent as oestrogen levels plummet and progesterone levels rise

These changes occur because it means sperm can more easily enter the cervix, because the lining is more slippery. Sperm also lives longer when suspended in cervical fluid at this time, as the acidic environment of the vagina would normally kill the sperm.

Some people attempt to track cervical fluid on its own without other factors, known as the cervical secretion method, but this is not a reliable birth control method. This is because several conditions can affect your vaginal discharge such as STIs (sexually transmitted infections) or vaginal infections (e.g. bacterial vaginosis).

Lactational amenorrhoea method (LAM)

What is LAM?

Another natural method of birth control is known as the lactational amenorrhoea method (LAM) which many women use as their main contraceptive whilst breastfeeding.

When you breastfeed, your body produces more prolactin and oxytocin to produce breast milk. However, another effect that they have is stopping ovulation. If you don’t ovulate, you can’t get pregnant.

Who can use LAM?

As the method relies on natural hormone fluctuations, women must be breastfeeding consistently in order for it to work.

In order for it to be effective, women must be

• nursing at least every 4 hours during the day or every 6 hours at night
• breastfeeding naturally - not using a breast pump or formula

How effective is LAM?

LAM is an effective and natural method. When done correctly, it is equally as effective as other birth control options.

However, the natural effects of breastfeeding will reduce the longer you breastfeed for. The effects will only last for around 6 months, until your period returns or you switch to formula / baby food.

LAM is a great option for postpartum women. However, it’s not a permanent solution and you should think about regular contraception as soon as possible after giving birth.

Withdrawal method

How does the withdrawal method work?

More colloquially known as “pulling out”, the withdrawal method is another form of birth control that many women still use as their main contraception. It involves the man removing his penis before ejaculation during sexual intercourse. This prevents pregnancy because the sperm does not enter the vagina.

Is the withdrawal method effective?

On paper, it’s an effective method when done correctly, but it is not as effective as other types of birth control such as hormonal methods and the IUD (intrauterine device).

“22 in every 100 women get pregnant using the withdrawal method”

It is also highly prone to user error, as it requires a specific technique. Even with perfect use, you could still get pregnant, as pre-ejaculate (pre-cum) contains sperm.

According to Planned Parenthood, around 22 out of 100 women each year become pregnant from using the withdrawal method. Therefore, it is not a commonly endorsed contraceptive method.

If you want to use the withdrawal method, it’s a good idea to keep emergency contraception spare in the event that it doesn’t go to plan.

What are the benefits of using natural methods?

When choosing any contraceptive method, it’s important to consider the benefits and risks. It will depend on your lifestyle and your preferences.

Here’s some potential benefits and risks to consider before trying LAM or other family planning methods.

Final thoughts

Natural birth control methods are a great and safe way to prevent pregnancy, especially if you’re worried about side effects or taking medication. However, they require hard work, patience and these methods are not suitable for everyone. Speak to a healthcare professional if you’re thinking about switching to natural methods.